Te Hira Care Home Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question Good. At this inspection the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us each person was assessed to identify their needs before the service accepted people. However, records of these assessments were not routinely available to show this happened. Whilst some records were available either on the electronic system or handwritten, these varied in the level of detail to support effective care planning. This meant care was not always based on accurate or complete information, increasing the risk that people’s needs may not be appropriately met. Despite this, staff told us they completed assessments of all people’s needs, and this information was put directly into care plans to guide staff in meeting people’s needs. Care plans completed demonstrated people had been involved in sharing information about their needs.

The provider did not make it clear they always planned and delivered people’s care and treatment with them, including what was important and mattered to them.

Risk assessments relating to people’s care had been completed which referenced recognised tools such as those used for skin care. However, records were not consistent in identifying risks to ensure these were fully reflected in people’s care plans so that it was clear how staff should manage them. For example, staff told us 1 person needed to be repositioned every 2 hours, but this was not reflected in the risk assessment or care plan. While staff demonstrated a good understanding of people’s needs, this was not supported by accurate records or clear guidance. This meant staff did not have clear guidance to follow, increasing the risk of inconsistent or unsafe care. Despite the lack of guidance in the person’s care plan, staff said they were repositioning the person regularly. Nobody in the home had skin care concerns at the time of our visit.

People told us how staff supported them with risks associated with their care. For example, 1 person told us staff helped them with their walking aid to help prevent them from falling.

The provider worked across teams and services to support people. They shared information when people moved between different services.

Staff told us family contacts, and information about any medicines people were taking was shared with hospital staff when people were admitted.

Staff described how they worked together as a team and how they used a handover meeting at the start of each shift to share information. One staff member told us, “We get a handover verbally at the start of every shift. You definitely have a full review of everyone (residents), how they have been, anything that is different. I would say we get all the information we need. Information sharing is good.”

Staff were positive about the support they provided to one another and also the support from the management team. One staff member said, “I would say we get on really well as a team. We talk about everything. We are like a family. We are open and honest.” Staff told us they accessed health professionals including district nurses for advice when needed to help support people’s care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had regular access to activities within the home to help support their health and wellbeing. People described how staff supported them to be independent for example dressing themselves and accessing areas of the home. Some people had walking aids to support them to walk independently. We saw 1 person had a large button telephone to help them use this independently.

Staff told us a nurse practitioner visited the home weekly so they could address any health concerns people had. District nurses also visited the service. One staff member said, “I work closely with the district nurse. Working closely helps the residents because we are all working together. I always fill in the records to say when the district nurse came, why they came and what they said. This makes sure everyone has access to the information.”

The provider did not always effectively monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Whilst arrangements were in place to monitor people’s care, records were not always sufficiently detailed to ensure effective monitoring took place to maintain people’s health. For example, 1 person’s repositioning charts did not state the frequency this was required to prevent skin damage. Whilst the care plan advised staff to check the skin daily, there were no instructions to staff to record any red areas (which may suggest potential skin damage), only wounds. A specialist mattress was in use, but there were no instructions in the care plan to state what setting this should be set at so this was used safely, and staff could monitor this was maintained. A care plan stated a pillow was to be used for repositioning but did not state where the pillow should be used. This reduced assurance that deterioration in people’s health would be identified and responded to in a timely way.

Where people were at risk of poor nutrition they were encouraged to eat and drink. One person told us, “They told me to drink plenty of water.” Supplementary records were used to show people’s food and fluid intake. However, we noted the volumes recorded and potentially consumed at any 1 time varied significantly. The operations manager advised this was because care staff added cumulative amounts of fluids provided at the end of their shift, as opposed to adding each individual amount consumed at the time given. This meant it was not possible to confirm people had received and consumed fluids regularly. Following our visit the operations manager advised this practice would stop and staff had been instructed to record consumption at the time given.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us their consent was sought prior to staff providing care. One person told us, “They say ‘are you alright with this’?”

Staff had knowledge of the Mental Capacity Act (MCA) and understood the principles behind best interest decisions and capacity to consent.Staff told us they always sought consent from people before providing care. One staff member said, “I always ask for consent. The residents have rights just like you or me. It’s one of the main things and I explain what I’m doing like, OK I’m just going to roll you over, you’re safe with me, don’t worry.”

People’s care records showed if they had capacity to make decisions. However, where people had an authorised DoLS in place, the reason was not always clearly recorded in their care plan. The operations manager assured us more detail would be added to people’s care plans.

The operations manager had maintained records that showed when a DoLS application had been submitted, the date it was authorised by the local authority, and the expiry date. This helped to ensure any renewals were applied for in good time. The operations manager said, “As soon as I receive the authorisation, I record it on my calendar drive, I enter the expiry date and then put a reminder date 28 days before expiry, so I know we have to make a new application.” Records confirmed this.